Genome-based epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in Spain: A prospective multicentre study.

BACKGROUND: Whole-genome sequencing (WGS) of Neisseria gonorrhoeae isolates combined with epidemiological and phenotypic data provides better understanding of population dynamics. AIM: The objective of this study was to investigate the molecular epidemiology of N. gonorrhoeae isolates from three centres in Spain and determine associations of antimicrobial resistance. METHODS: Genetic characterization was performed in 170 N. gonorrhoeae isolates. WGS was carried out with the HiSeq platform (Illumina). Genome assemblies were submitted to the PubMLST Neisseria database website to determine NG-MAST, MLST and NG-STAR. Antimicrobial resistance genes and point mutations were identified with PubMLST. Phylogenomic comparison was based on whole-genome single nucleotide polymorphism analysis. RESULTS: Twenty-six MLST, 49 NG-MAST and 41 NG-STAR sequence types were detected, the most prevalent being MLST-ST9363 (27.1%), NG-MAST ST569 (12.4%) and NG-STAR ST193 (14.7%). Phylogenetic analysis identified 13 clusters comprising 69% of the isolates, with two of note: one involved cefixime-resistant isolates from Barcelona presenting a mosaic penA X and belonging to MLST-ST7363 and the other involved azithromycin-resistant isolates from Mallorca that possessed the C2611T mutation in the four 23S rRNA alleles belonging to MLST-ST1901. CONCLUSION: The population of N. gonorrhoeae is quite heterogeneous in Spain. Our results agree with previous data published in Europe, albeit with some differences in distribution between regions. This study describes the circulation of two gonococcal populations with a specific resistance profile and sequence type in a specific geographic area. WGS is an effective tool for epidemiological surveillance of gonococcal infection and detection of resistance genes.

Relevance of Allergenic Sensitization to Cynodon dactylon and Phragmites communis: Cross-reactivity With Pooideae Grasses.

BACKGROUND AND OBJECTIVES: The homologous group of sweet grasses belongs to the Pooideae subfamily, but grass pollen species from other subfamilies can also cause allergy, such as Cynodon dactylon (Chloridoideae) and Phragmites communis (Arundinoideae). C dactylon and P communis have not been included in the sweet grasses homologous group because of their low cross-reactivity with other grasses. The aims of this study were to investigate the profile of sensitization to C dactylon and P communis in patients sensitized to grasses and to analyze cross-reactivity between these 2 species and temperate grasses. METHODS: Patients were skin prick tested with a grass mixture (GM). Specific IgE to GM, C dactylon, P communis, Cyn d 1, and Phl p 1 was measured by ImmunoCAP. A pool of sera was used for the immunoblot assays. Cross-reactivity was studied by ELISA and immunoblot inhibition. RESULTS: Thirty patients had sIgE to GM. Twenty-four (80%) had positive results for C dactylon, 27 (90%) for P communis, 22 (73.3%) for nCyn d 1, and 92.9% for rPhl p 1. Bands were detected in the 3 extracts by immunoblot. Inhibition of GM was not observed with C dactylon or P communis by immunoblot or ELISA inhibition. When C dactylon or P communis were used in the solid phase, GM produced almost complete inhibition. CONCLUSIONS: Eighty percent of patients sensitized to grasses were also sensitized to C dactylon and 90% were sensitized to P communis. Sensitization to these species seems to be induced by allergens different to those in sweet grasses.

Relevance of allergenic sensitization to cynodon dactylon and Phragmites communis: cross-reactivity with pooideae grasses

Background and Objectives: The homologous group of sweet grasses belongs to the Pooideae subfamily, but grass pollen species from other subfamilies can also cause allergy, such as Cynodon dactylon (Chloridoideae) and Phragmites communi (Arundinoideae). C dactylon and P communis have not been included in the sweet grasses homologous group because of their low cross-reactivity with other grasses. The aims of this study were to investigate the profile of sensitization to C dactylon and P communis in patients sensitized to grasses and to analyze cross-reactivity between these 2 species and temperate grasses. Methods: Patients were skin prick tested with a grass mixture (GM). Specific IgE to GM, C dactylon, P communis, Cyn d 1, and Phl p 1 was measured by ImmunoCAP. A pool of sera was used for the immunoblot assays. Cross-reactivity was studied by ELISA and immunoblot inhibition. Results: Thirty patients had sIgE to GM. Twenty-four (80%) had positive results for C dactylon, 27 (90%) for P communis, 22 (73.3%) or nCyn d 1, and 92.9% for rPhl p 1. Bands were detected in the 3 extracts by immunoblot. Inhibition of GM was not observed with C dactylon or P communis by immunoblot or ELISA inhibition. When C dactylon or P communis were used in the solid phase, GM produced almost complete inhibition. Conclusions: Eighty percent of patients sensitized to grasses were also sensitized to C dactylon and 90% were sensitized to P communis. Sensitization to these species seems to be induced by allergens different to those in sweet grasses (AU)

Antecedentes y Objetivos: Desde un punto de vista taxonómico, el grupo homólogo de las gramíneas pertenece a la sub-familia Pooideae. Sin embargo, existen también otras especies de gramíneas alergénicas que pertenecen a sub-familias diferentes como son Cynodon dactylon (Chloridoideae) o Phragmites communis (Arundinoideae). C. dactylon y P. communis no están incluidas en este grupo homólogo debido a que la reactividad cruzada con otras gramíneas es limitada. Los objetivos del estudio fueron investigar el perfil de sensibilización a C. dactylon y P. communis en pacientes sensibilizados a gramíneas y analizar la reactividad cruzada entre estas dos especies y las gramíneas más comunes. Métodos: A los pacientes se les realizó una prueba cutánea con una mezcla de gramíneas (MG). Mediante ImmunoCAP se midió la IgE específica para MG, C. dactylon P. communis , Cyn d 1 y Phl p 1. Un pool de sueros se utilizó para ensayos de inmunoblot. La reactividad cruzada se estudió mediante ELISA e inmunoblot inhibición Resultados: Treinta pacientes tuvieron IgE específica para MG. Veinticuatro (80%) fueron positivos a C. dactylon, 27 (90%) a P. communis, 22 (73,3%) a nCyn d 1 y 92,9% fueron positivos a rPhl p 1. Se detectaron bandas en los tres extractos mediante inmunoblot. No se observó inhibición de MG con las otras dos especies mediante inmunoblot o ELISA inhibición. Cuando C. dactylon o P. communis se usaron en fase sólida, MG produjo una inhibición casi completa. Conclusiones: El 80% de los pacientes sensibilizados a gramíneas estaban también sensibilizados a C. dactylon y el 90% a P. communis. La sensibilización a estas especies parece estar inducida por diferentes alérgenos que en el caso de gramíneas (AU)

Description of sunflower seed–fungus syndrome

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Edema of the uvula: etiology, risk factors, diagnosis, and treatment.

Edema of the uvula (EU) is a rare occurrence sometimes associated with angioedema, urticaria, and anaphylaxis. We analyze the causes, predisposing factors, and characteristics of EU in a group of 58 patients with a mean (SD) age of 48.2 (15.2) years over the course of a year. Of the 58 patients studied, 49 (84.5%) were male and 44 (75.9%) presented isolated EU. Thirty-two patients (55.1%) with no clear etiology were classed as idiopathic. Snoring and a high body mass index were more prevalent in these patients. A variety of probable causes were identified in 26 patients (44.9%). In this group, EU was usually accompanied by urticaria, angioedema, and anaphylaxis and there was also a greater prevalence of atopy. We found that EU was idiopathic in just over half of the patients studied and that the predisposing factors were being overweight and having a tendency to snore. Patients with EU should be tested for allergies to drugs, airborne allergens, and food.

Anaphylactic shock as the cause of myocardial infarction in a woman with normal coronary arteries

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Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Majorcan hospitals: high prevalence of the epidemic clone EMRSA-15.

Clinical isolates (n = 389) of methicillin-resistant Staphylococcus aureus (MRSA) recovered from 371 patients between January 2003 and June 2004 at the three major public hospitals on the island of Majorca, Spain were studied. The clonal relatedness of MRSA isolates was determined by pulsed-field gel electrophoresis (PFGE) after digestion with SmaI. During the study period, MRSA was found in 31% of patients with S. aureus-positive cultures. PFGE analysis identified three predominant clones, affecting 94% of the patients. The three clones had been detected since 1999 in one hospital, and were designated as clones A, B and C. Whereas clones A and B (multidrug-resistant) were related to the two most prevalent clones in Spain at this time, clone C was identical to EMRSA-15, currently one of the most common MRSA clones in UK hospitals and also detected in other countries, but rarely in Spanish hospitals. This imported epidemic clone was detected in c. 10% of patients admitted to one of the three hospitals in 2002, but its prevalence has increased significantly (32% of the patients investigated in the three hospitals in the present study), and this clone also accounted for 44% of the isolates from non-hospitalised patients. Even though EMRSA-15 showed the least multidrug resistance of the three major clones, it was apparently more virulent, since it was associated significantly (p 0.001) with bacteraemia, and positive blood cultures were documented for 21% of the patients infected by this clone, compared with only 10% and 7% of patients infected with clones A and B, respectively.